颈淋巴结清扫术后乳糜漏是颈部外科手术后比较少见的并发症，国内、外文献［1-7］报道其发生率约为1%～3%，其原因很明确，即术中损伤胸导管或其分支。颈淋巴结清扫术后乳糜漏对生命有潜在威胁，且显著延长患者住院时间、增加医疗费用。尽管手术方法及手术器械不断改进，其发生率并没有明显降低，对于部分难治性乳糜漏目前还没有简单有效的办法。现就颈淋巴结清扫术后乳糜漏的预防及治疗方法介绍如下……
ObjectiveTo investigate the relationship between p53 gene family and thyroid cancer.MethodThe related literatures in the database were reviewed and analyzed.ResultsThe p53 gene family included p53, p63, and p73. The p53 played an important role in the development of thyroid cancer, especially in the development of undifferentiated thyroid cancer. The different subtypes of p63 might have different roles in the thyroid cancer, so it couldn’t be generally said that the p63 was an oncogene or an anti-oncogene, and the function of its specific protein needed to be further studied. The biological role of p73 in the thyroid cells might be contradictory, depending on the interaction of many different factors, and the interaction between various p73 subtypes and members of the p53 molecular network was still unclear.ConclusionThere is still some controversy about role of p53 gene family in development of thyroid cancer.
ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P＜0.001); the surgical complications showed no significant difference between the HS and CH group (Pgt;0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P＜0.05); the surgical complications after learning curve were significantly lower than that in learning curve in HS group (P＜0.001). Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can’t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.
Objective To summarize the research progress of the treatment of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasm type 1 (MEN1). Method The literature about the treatment of PHPT in MEN1 in recent years was reviewed. Results When the symptoms of MEN1 related PHPT were obvious, surgery was an effective treatment. In addition to conventional total parathyroidectomy with autotransplantation and subtotal parathyroidectomy, less-than subtotal parathyroidectomy, and single gland excision had also been proved to be effective recently. Conclusions Combining the clinical manifestations with the actual involvement of the parathyroid of MEN1 related PHPT patients, personalized selection of appropriate timing and methods of parathyroidectomy can help MEN1 related PHPT patients obtain ideal parathyroid function and ensure the quality of life to the greatest extent.
ObjectiveTo understand the role of calcitonin testing for the diagnosis and treatment of medullary thyroid cancer (MTC) as well as recent research progress, so as to provide assistance in the early clinical diagnosis and treatment of MTC and improve patients’ prognosis. MethodThe literatures about the role of calcitonin testing in MTC in recent years were reviewed. ResultsIn recent years, both domestic and international scholars had extensively investigated the role of calcitonin in the early detection of MTC and accurate postoperative prognosis assessment. With respect to early diagnosis, advancements had been made in the three main measurement methods: basal calcitonin, stimulated calcitonin, and calcitonin measurement in the thyroid nodule fine-needle aspiration washout fluid. These developments in calcitonin levels had contributed to improved guidance in surgical treatment and prognosis evaluation. While calcitonin monitoring could inform treatment decisions and improve patients’prognosis, numerous challenges remain to be addressed. ConclusionThe study of calcitonin detection can deepen the understanding of MTC, further research on calcitonin related detection in the future will be of great significance for the diagnosis, treatment and prognosis evaluation of MTC.
Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection, exposure and protection of the RLN during the surgical procedures.Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact, the rest 2 nerves were resected because of tumor involving. Conclusions NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery, especially reoperation.
目的 探讨铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的方法及效果。方法 笔者所在医院2012年4月至2012年7月期间共治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏患者4例，均采用铜绿假单胞菌注射液治疗。将铜绿假单胞菌注射液（1mL或2mL）通过引流管逆行注射到创腔，夹闭引流管1h后再开放引流管。结果 4例患者注射前1d24h引流量分别为200、350、540及810mL，其中2例患者为乳糜漏，引流时间分别为7d和15d；另2例患者为单纯淋巴漏，引流时间分别为13d和14d。注射1d后，引流量分别减少至20、45、120及255mL，4d后4例患者均顺利拔除引流管。4例患者治疗后均有不同程度的发热，经物理降温后体温恢复；均有不同程度的局部疼痛感，3例患者疼痛能耐受，另1例疼痛剧烈患者予以美洛昔康口服后缓解。结论 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏的疗效显著。
ObjectiveTo investigate the cause and treatment for chyle fistula after neck radical dissection using harmonic scalpel. MethodsFrom January 2005 to April 2009, 105 patients with thyroid carcinoma underwent thyroidectomy by harmonic scalpel (harmonic scalpel group) and 110 patients with thyroid carcinoma by conventional procedures (conventional group). Postoperative chyle fistula in all the cases was studied retrospectively. ResultsThe incidence of chyle fistula was 5.71% (6 of 105 patients) in the harmonic scalpel group and 0.91% (1 of 110 patients) in the conventional group. The difference was significant between two groups (Plt;0.05). ConclusionsHarmonic scalpel increases the risk of chyle fistula in neck radical dissection. The conventional procedures with exposing and preserving or ligating the thoracic duct can reduce the risk significantly.